A low probability/high impact event just ratcheted up a notch on the probability scale. Still low for any given individual, but of high enough impact that it warrants attention.

__________________"Now, mark my words. So long as we are a young and virtuous people, this instrument will bind us together in mutual interests, mutual welfare, and mutual happiness. But when we become old and corrupt, it will bind us no longer" - Alexander Hamilton about the US Constitution.

The real threat is a mutation that makes it more transmissible. That would be a game changer. But there don't seem to be any good ways to model that probability. We don't know if it's a 1 in a million (or zero for that matter), or if it's some higher probability.

Nor do we know how the virus will react in cold climates, like the US in winter. Ebola may have been w us for thousands of years. But it's always been in the tropics.

dietrich, I've read ebola can stay in the open on cold surfaces many times longer than hot. This would mean to me that during winter, surfaces have a higher chance of having ebola since it won't die as quickly.

The real threat is a mutation that makes it more transmissible. That would be a game changer. But there don't seem to be any good ways to model that probability. We don't know if it's a 1 in a million (or zero for that matter), or if it's some higher probability.

Nor do we know how the virus will react in cold climates, like the US in winter. Ebola may have been w us for thousands of years. But it's always been in the tropics.

Not to split hairs, but they proved it could infect under those conditions. Whether a victim could produce the number of virus particles required to transmit to and infect another under these conditions was not studied.

__________________"Now, mark my words. So long as we are a young and virtuous people, this instrument will bind us together in mutual interests, mutual welfare, and mutual happiness. But when we become old and corrupt, it will bind us no longer" - Alexander Hamilton about the US Constitution.

Last edited by Exodia; 10-01-2014 at 12:04 PM.
Reason: type faster than I think

Here's a quick list off the top of my head of the people exposed to Ebola when Duncan was symptomatic and spewing highly contagious fluids (spit, sweat, vomit, snot, and diarrhea among them):

1) Immediate family, adults and children
2) ER doctors/nurses/staff from his 1st trip to the ER
3) Other people in the ER then and after his departure
4) EMT's/ambulance drivers who worked on him on 26th
5) All EMT's, ambulance drivers, patients, and others who were in that ambulance over next 2 days
6) Everyone in the community who interacted with him, took money from him, opened the same doors after him, sat where he did, etc.
7) All HCW's involved in his current care

Wonder what he did during his 4 days out and about as a contagious spreader? Where all did he go? What did he touch? Did he get any explosive diarrhea while out and need to use a public restroom? How many doors did he touch with sweaty hands after wiping snot off his nose? Did he go to the grocery store and feel up any fruits/vegetables?

Regardless of whether this outbreak gets quickly snuffed out, it's easy to see how problematic things will be when dozens of these outbreaks are occurring all over the country as more and more infected people travel/flee into the US.

I found these comments, both by the same person, on a reddit thread about ebola very interesting:

Quote:

There's nothing preventing ebola from becoming less virulent over time.
Worst case scenario would be that it evolves a way for the host to shed viral particles during the pre-symptomatic stage (which can last weeks).
I work at the CDC, and some are currently investigating post-recovery transmission pathways. It seems that Ebola remains in vaginal fluids and semen for quite a long time (up to 9mo). To my knowledge, we're not yet sure if those viral particles are infectious...and if so, for how long.

Quote:

I've recently seen figures that show up to 9mo. That being said, it was clear that it was a grey area that is being actively researched...so I would say the jury is still out...and not to worry just yet.
Again, just because we can detect presence of viral DNA in a clinical sample does not necessarily mean that it is capable of infectious transmission.
I'm not sure what they use to determine presence of Ebola, but I doubt they look deeply enough to determine whether the viral machinery is still functioning normally.
Sorry, I work in the HIV branch so I'm far from an expert on Ebola.

__________________“When the situation was manageable it was neglected, and now that it is thoroughly out of hand we apply too late the remedies which then might have effected a cure. There is nothing new in the story. It is as old as the sibylline books. It falls into that long, dismal catalogue of the fruitlessness of experience and the confirmed unteachability of mankind. Want of foresight, unwillingness to act when action would be simple and effective, lack of clear thinking, confusion of counsel until the emergency comes, until self-preservation strikes its jarring gong–these are the features which constitute the endless repetition of history.”
— Winston Churchill, House of Commons, 2 May 1935.

• Sept. 19. Thomas Eric Duncan leaves Monrovia, Liberia, for a trip to the United States. He has been exposed to Ebola but is not exhibiting symptoms, so he is not contagious. It is unclear whether he knew he had been exposed.

• Sept. 20. After changing planes in Brussels, Belgium, and at Washington Dulles International Airport, Duncan arrives in Dallas to visit his sister.

• Sept. 24. Duncan's family members tell U.S. authorities this is the day he first felt sick. That is when he likely became contagious.

• Sept. 26. Duncan seeks treatment at Texas Health Presbyterian Hospital Dallas and is sent back to his sister's apartment with antibiotics.

• Sept. 28. Duncan is transported to the same hospital by ambulance. He is critically ill and put in isolation in the hospital's intensive care unit.

• Sept. 30. The federal Centers for Disease Control and Prevention confirms that Duncan has been stricken with the Ebola virus, the first patient to be diagnosed in the USA.

• Oct. 1. Duncan's condition is upgraded from critical to serious, and health officials say they are closely monitoring a second patient who had contact with Duncan. Others who have been in contact with Duncan, including paramedics and children, are being observed for symptoms

andy - today, tomorrow & Friday cover the typical 8-10 day incubation period. Mind you, that incubation period guideline was developed based on historical outbreaks... which happened in a 3rd world country. Living in the west under better conditions of sanitation, better nutrition, etc. might extend that a day or more. I have no idea.

The White House said Wednesday it will not impose travel restrictions or introduce new airport screenings to prevent additional cases of Ebola from entering the United States.

Spokesman Josh Earnest said that current anti-Ebola measures, which include screenings in West African airports and observation of passengers in the United States, will be sufficient to prevent the “wide spread” of the virus.

The chances of a U.S. epidemic are “incredibly low,” he said.

“The reason for that is that it is not possible to transmit Ebola through the air. ... The only way that an individual can contract Ebola is by coming into contact with the bodily fluids of someone who is exhibiting symptoms.”

__________________
"You can solve all the world's problems in a garden." Geoff Lawton

Kids are germ factories & very touchy-feely & tend to be poor in the hygiene department. Look how quickly EV-68 is spreading. The kids MAY have been contacts from the day he became ill & IF infected would be showing symptoms or about to be.

Conventional wisdom says Ebola isn't infectious until patients are symptomatic. That's a little too fuzzy for my liking. At noon, you feel fine & you can't transmit the virus. Ten minutes later, you experience a slight wave of weakness & feel warm - fever starting. In those 10 minutes, you DO become infectious? Are early symptoms to be seen as a "Coming Out into Society" announcement in the local paper - Epidemic Weekly?

Maybe kids do shed virus in advance of symptoms - we don't know. If it were your child, would you take that risk?

Does anyone remember the big mess when hospitals were under suspicion that they didn't run tests needs on some uninsured patients due to cost? And even d/c'd some who died carrying the d/c paperwork a few blocks away?

I kinda wonder if hospital staff are still told to be aware of costs for those who have no ins and can not pay. They are suppose to treat you anyways but what if......

playing the odds this was not ebola (after all others in the USA have been isolated and tested neg then released) this time it backfired?

Face it, who pays for it is a thought most have even in an ER....

__________________
My thoughts don't feel like electric chemistry, but that is what they are- Henry Marsh, neurosurgeon.

Sandyd, I think you may be on to something. I think Mr Duncan and his family were very aware he had Ebola. I doubt they failed to give that information to the first hospital. That hospital gambled (HUGE cost vs possibility of false negative) and they lost.

Ebola Patient Thomas Eric Duncan's Nephew: I Had to Call CDC

The first person diagnosed with the Ebola virus in the U.S. wasn't appropriately treated for suspected infection until after a relative personally called the Centers for Disease Control and Prevention, his nephew told NBC News on Wednesday night.

Health officials have acknowledged that Thomas Eric Duncan, 42, was initially sent home from Texas Health Presbyterian Hospital in Dallas when he showed up on Sept. 26 complaining of fever and abdominal pain. He had to return two days later in an ambulance.

That was the day "I called CDC to get some actions taken, because I was concerned for his life and he wasn't getting the appropriate care," Duncan's nephew, Josephus Weeks, told NBC News on Wednesday night. "I feared other people might also get infected if he wasn't taken care of, and so I called them to ask them why is it a patient that might be suspected of this disease was not getting appropriate care?"

Weeks added that he hoped "nobody else got infected because of a mistake that was made."

Two days after a Texas man who had recently visited Liberia was diagnosed with Ebola, a Missouri doctor Thursday morning boarded a plane at Atlanta’s Hartsfield-Jackson International Airport dressed in full protection gear to protest what he called mismanagement of the crisis by the federal Centers for Disease Control and Prevention.
Dr. Gil Mobley checked in and cleared airport security wearing a mask, goggles, gloves, boots and a hooded white jumpsuit emblazoned on the back with the words, “CDC is lying!”

“If they’re not lying, they are grossly incompetent,” said Mobley, a microbiologist and emergency trauma physician from Springfield, Mo.

Mobley said the CDC is “sugar-coating” the risk of the virus spreading in the United States.

“For them to say last week that the likelihood of importing an Ebola case was extremely small was a real bad call,” he said.

__________________"Now, mark my words. So long as we are a young and virtuous people, this instrument will bind us together in mutual interests, mutual welfare, and mutual happiness. But when we become old and corrupt, it will bind us no longer" - Alexander Hamilton about the US Constitution.

I actually found a pretty decent price on big tyveck suits with elastic cuffs and a hood. Almost pulled the trigger.

__________________"Now, mark my words. So long as we are a young and virtuous people, this instrument will bind us together in mutual interests, mutual welfare, and mutual happiness. But when we become old and corrupt, it will bind us no longer" - Alexander Hamilton about the US Constitution.

__________________"Now, mark my words. So long as we are a young and virtuous people, this instrument will bind us together in mutual interests, mutual welfare, and mutual happiness. But when we become old and corrupt, it will bind us no longer" - Alexander Hamilton about the US Constitution.